Highlights
- •High illness severity is common and associated with increased mortality.
- •High comorbidity is less frequent but also associated with increased mortality.
- •Illness severity and comorbidity interact to accentuate the effect of comorbidity on mortality.
Abstract
Background
The extent to which illness severity and comorbidity determine the outcome of an emergency
medical admission is uncertain. We aim to quantitate the relative effect of these
factors on mortality.
Methods
We evaluated all emergency medical admission to our institution between 2002 and 2018.
We derived an Acute Illness Severity Score (AISS) and Comorbidity Score from admission
data and International Classification of Diseases codings. We employed a multivariable
logistic regression model to relate both to 30-day in-hospital mortality.
Results
There were 113,807 admissions in 58,126 patients. Both AISS, Odds Ratio (OR) 4.4 (95%CI
3.5, 5.5), and Comorbidity Score, OR 1.91 (95%CI 1.67, 2.18), independently predicted
30-day in-hospital mortality. The two highest AISS risk groups encompassed 46.5% of
admissions with predicted mortality of 5.9% (95%CI 5.7%, 6.1%) and 14.4% (95%CI 13.9%,
14.8%) respectively. Comorbidity Score >=10 occurred in 17.9% of admissions with a
predicted mortality of 13.3%. AISS and Comorbidity Score interacted to adversely influence
mortality; the threshold effect for Comorbidity Score was reduced at high levels of
AISS.
Conclusion
High AISS and Comorbidity Scores were predictive of 30-day in-hospital mortality and
relatively common in emergency medical admissions. There is a strong interaction between
the two scores.
Keywords
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Article info
Publication history
Published online: November 22, 2019
Accepted:
November 17,
2019
Received in revised form:
October 23,
2019
Received:
August 12,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
